Investigation: nH Predict used to deny Medicare Advantage benefits

H Predict and similar tools are being used by insurance companies to determine whether patients enrolled in US Medicare Advantage programmes are worthy of care, and are driving the denial of benefits. According to a STAT investigation , nH Predict and other tools were being used 'to pinpoint the precise moment when they can shut off payment for a patient’s treatment,' particularly for the elderly and disabled, and the denials that followed 'are setting off heated disputes between doctors and insurers'. It later emerged that NaviHealth clinicians were becoming increasingly concerned that their UnitedHealth bosses were letting nH Predict override their own medical expertise . STAT also reported that NaviHealth managers insisted the algorithm was followed precisely so that payments could be cut off by the dates predicted. System 🤖 nH Predict Operator: Humana Inc; UnitedHealth Group Developer: UnitedHealth Group; Cardinal Health; SeniorMetrix Country: USA Sector: Health Purpose: Predict post-acute care needs Technology: Prediction algorithm Issue: Accountability; Fairness Legal, regulatory 👩🏼‍⚖️ Estate of Gene B. Lokken and the Estate of Dale Henry Tetzloff v UNITEDHEALTH GROUP, INC., UNITEDHEALTHCARE, INC., NAVIHEALTH, INC., and DOES 1-50, inclusive Investigations, assessments, audits 🧐 STAT (2023). How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care STAT (2023). Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need STAT (2023). Buyer’s remorse: How a Medicare Advantage business is strangling one of its first funders

Date it happened

2023-03-01

Organisation involved

Humana Inc; UnitedHealth Group

Product, system or model

nH Predict

This is a record of what was reported, not a finding that anyone broke the law. If it names your organisation and you believe it is wrong, the corrections process is free and open to everyone.